Can the declaration be signed electronically?

Yes in most circumstances. Electronic signatures are legally equivalent under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in 49 states, but exceptions may apply; verify state execution rules for advance directives.

Are witnesses or a notary always required?

Requirements vary by state. Some states require witnesses and others require notarization; a few accept either. Confirm the local statute or use the state-specific official form where available.

Who may sign if the patient lacks capacity?

If the declarant lacks capacity, a prior valid signed declaration controls. Without a valid declaration, authorized health care agents or guardians may make decisions per state law.

How can I revoke or change the declaration?

You can revoke by executing a new directive, signing a revocation in writing, or in many states by orally communicating intent in front of witnesses; follow state-specific revocation formalities.

Is remote notarization allowed?

Remote Online Notarization (RON) rules differ by state; many states permit RON with identity proofing and audio-video recording requirements, but verify your state notary commission guidance.

How should signed forms be stored and accessed?

Keep originals with medical records, provide copies to clinicians and your agent, and store encrypted electronic copies with audit trails to satisfy retention and access needs.

Electronic Signature
Templates
Other
Life Prolonging Procedures Declaration

Life Prolonging Procedures Declaration

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

What the Life Prolonging Procedures Declaration Is

A Life Prolonging Procedures Declaration is a written advance directive used in the United States to record an individual's instructions about acceptance or refusal of life-prolonging medical treatments if they become terminally ill or permanently unconscious and cannot communicate. It is a focused form of a living will that addresses interventions such as cardiopulmonary resuscitation, mechanical ventilation, dialysis, artificial nutrition and hydration, and certain antibiotic or surgical measures. States treat the document as legally significant when executed according to local rules, and it commonly works together with a durable power of attorney for health care or a health care proxy.

Why a Clear Declaration Matters for Patients and Providers

A Life Prolonging Procedures Declaration clarifies patient preferences, guides clinicians under stressful conditions, and reduces family uncertainty by documenting specific treatment choices in advance.

Who Completes and Relies on This Declaration

Individuals planning advance care, clinicians documenting treatment limits, and appointed health care agents rely on this document for clear instructions.

Patients and competent adults who want defined choices about life-prolonging interventions.
Health care proxies or agents appointed to make decisions if the patient is incapacitated.
Hospitals, hospice programs, and long-term care providers who implement documented patient directives.

Keep the signed declaration accessible to treating providers and give copies to proxies, family, and medical records so it can be followed when needed.

Stepwise Process to Complete the Declaration

Follow these core steps to create a valid, enforceable Life Prolonging Procedures Declaration.

01

Identify Preferences: Decide specific treatments to accept or refuse.
02

Designate Agent: Name a health care agent and alternates.
03

Execute Properly: Sign with required witnesses or notarization.
04

Distribute Copies: Provide copies to providers and your proxy.

Typical Digital Workflow Settings for Online Completion

When completing online, configure basic fields and signer order to reflect legal execution and recordkeeping needs.

Field	Recommended setting
Signer Order	Patient first, witnesses/notary second
Authentication	Email + SMS code for identity check
Audit Trail	Enable full event logging and timestamps
Document Retention	Store encrypted copy for minimum retention period

How Electronic Completion and Delivery Typically Works

A common online flow reduces manual handling while preserving evidence of consent and execution.

Upload: Sender uploads the declaration template.
Place Fields: Add signature, initial, and date fields.
Authenticate: Signers verify identity and sign digitally.
Store: System saves a certified audit trail and document copy.

Essential Sections to Include in a Professional Declaration

A well-drafted Life Prolonging Procedures Declaration groups instructions, authority, and execution details to reduce ambiguity and legal risk.

Declaration Language

Clear, affirmative statements about acceptance or refusal of treatments with specific examples to avoid interpretive disputes.

Scope of Procedures

List interventions such as CPR, mechanical ventilation, dialysis, feeding tubes, and antibiotics to clarify intent.

Effective Date

State when the declaration becomes operative and whether it applies only in terminal/incapacitated conditions.

Health Care Proxy

Identify an agent with contact details and any limitations on decision-making authority.

Witness and Notary

Specify witness requirements and include a notary block if state law or the form requires notarization.

Revocation Terms

Explain how the declarant can revoke or amend the declaration orally, in writing, or by executing a new document.

Security and Compliance Essentials for Stored Declarations

HIPAA: Protected health information rules apply

ESIGN / UETA: Electronic signature statutes recognized

Encryption: TLS 1.2/1.3 and AES-256 used

Audit Trail: Event log with timestamps retained

BAA Availability: Business Associate Agreement required

Access Controls: Role-based permissions recommended

Consequences and Legal Risks of Improper Execution

Invalid Document: May be unenforceable

Delayed Care: Treatment delays while parties dispute

Family Conflict: Increased litigation risk

Professional Liability: Provider uncertainty increases risk

Administrative Costs: Higher legal or court expenses

Recordkeeping Failures: Noncompliant storage may violate HIPAA

Common Drafting and Execution Mistakes to Avoid

Using vague terms like 'extraordinary measures' without examples, which leads to differing clinical interpretations and inconsistent application.
Omitting witness or notary steps required by the state, which can render the declaration invalid when the executive capacity is later questioned.
Failing to provide copies to treating clinicians and the appointed agent, resulting in delays or disregard of patient preferences during urgent care.
Mixing contradictory statements across documents (e.g., a different instruction in a living will), which can create grounds for legal dispute or provider uncertainty.

Representative eSignature Pricing and Feature Comparison

Compare common vendor starting prices and key capabilities relevant to signing and storing sensitive health directives; signNow is listed first per comparison rules.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Verify with vendor	Verify with vendor	Verify with vendor	Verify with vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Technical and Integration Considerations for eSubmission

Ensure your chosen platform supports secure storage, required authentication, and integrations with clinical systems.

Integrations: Salesforce, Microsoft 365, NetSuite and cloud storage platforms supported
Formats: PDF, DOCX, HTML accepted for upload and signing
Authentication: Email, SMS code, and advanced options available

Frequently Asked Questions About Execution and Use

Answers to common questions about electronic signing, witnesses, revocation, and state-specific concerns related to Life Prolonging Procedures Declarations.

Need help? Contact support

Can the declaration be signed electronically?
Yes in most circumstances. Electronic signatures are legally equivalent under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in 49 states, but exceptions may apply; verify state execution rules for advance directives.
Are witnesses or a notary always required?
Requirements vary by state. Some states require witnesses and others require notarization; a few accept either. Confirm the local statute or use the state-specific official form where available.
Who may sign if the patient lacks capacity?
If the declarant lacks capacity, a prior valid signed declaration controls. Without a valid declaration, authorized health care agents or guardians may make decisions per state law.
How can I revoke or change the declaration?
You can revoke by executing a new directive, signing a revocation in writing, or in many states by orally communicating intent in front of witnesses; follow state-specific revocation formalities.
Is remote notarization allowed?
Remote Online Notarization (RON) rules differ by state; many states permit RON with identity proofing and audio-video recording requirements, but verify your state notary commission guidance.
How should signed forms be stored and accessed?
Keep originals with medical records, provide copies to clinicians and your agent, and store encrypted electronic copies with audit trails to satisfy retention and access needs.

Explore Templates

Mortgages and Deeds for County of Berks Pennsylvania Fixed Rate Installment Promissory Note Uniform Acknowledgment Act Divorce Procedure Pennsylvania Courts Revocation of Health Care Durable Power of Attorney Id Theft Victim Assistance Form

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now